I follow Nick Hodgson who is the media manager for RCPsych, I recently read on Twitter that he is also the son-in-law of Prof Sir Simon Wessely and Prof Clare Gerada but this later turned out to be untrue.
I notice that the RCPsych only circulates information promoting the benefits of SSRI antidepressants, so stories of patients benefiting are welcome and highly praised, stories of patients who have been harmed are completely ignored. If the public wants accurate information about the drugs, the Royal College is not the place to find it.
Nick Hodgson was the first to circulate on Twitter the letter to the Times newspaper written by Profs Burn and Baldwin, he lauded its content despite there being no supporting evidence for the statement in it about antidepressant withdrawal. This letter has resulted in a formal complaint by 30 professionals and patients, a complaint dismissed by RCPsych. A fresh complaint has now been submitted to the Secretary of State for Health about the unprofessional conduct of the Royal College with respect to this matter.
Yesterday I noticed that Nick Hodgson was lauding the praises of an article in the Times by Hannah Betts who takes antidepressants and finds them helpful. Of course she is perfectly free to write about her experiences in the Times newspaper but the way she approached this subject left a great deal to be desired in my opinion.
She starts off …
“The Times has been reporting that one in six people in England had recourse to antidepressants last year — up by almost half a million since 2015 — including 70,000 under-18s and 2,000 primary schoolchildren. Obviously, this throws up entirely laudable anxieties about medicalising adolescence, shaping growing brains and pill popping among the elderly when human contact might be preferable, not least given inadequate provision of talking cures. The health secretary, Matt Hancock, has promised alternatives to “unsophisticated drugs”, such as gardening and arts clubs.”
She then assumes that for many millions of patients they do “work”, an assumption that is debatable. Even the RCPsych states on its website that a minority derive real benefit over placebo, and of course there is ample evidence of harm from these drugs and worsening depression after long term use. I have read that the number needed to treat is about 1 in 9 .. that would surely mean that less than 10% benefit although these figures do seem hard to fathom if not an expert. If 1 in 9 is correct and there are 9 million taking the medication, then surely the majority will not benefit but as I say I am not an expert and do not claim to be.
She continues ..
“In our alarm that unnecessary drug dependency might be a sticking plaster for lack of funding, we mustn’t ignore the fact that — for many millions of us — the drugs do work; which is why we take them. Far from proving “unsophisticated”, they are a daily miracle allowing us to function — a benefit no previous generation enjoyed. Depression kills, as those of us who have lost loved ones to it can testify. SSRIs not only save lives, but make them worth living. And I, for one, am grateful.”
She has repeated the stock phrases such as SSRIs “save lives”, without even mentioning the many lives that are in fact lost to suicide after taking these drugs, there is not even a hint that she is aware of the ongoing patient campaign about widespread iatrogenic harm, although she clearly appreciates the concerns about drug dependence. She expresses no concern for the many patients left in states of disability and distress after being prescribed these medications. She also does not realise that the drugs have been on the market for many decades, I was first prescribed them some 30 years ago. If I had a child or a grand-child they could very well now be on an SSRI antidepressant. As they are being prescribed to very young children I could even have a great grand-child on these drugs.
She says ..
” … as someone who this very evening will be asking her doctor to up her happy pill dose — I can tell you that a little light weeding isn’t going to cut it when you’re too blighted by misery to move.”
The author’s father and grandfather are psychiatrists and so she is likely to have a particular perspective. I was surprised that she described the antidepressant she takes as a “happy pill”, a term that many depressed patients find offensive because of course in the main they do not make people happy. And she now feels she needs a higher dose to get the same effect. What will happen when the effect of the higher dose wears off? Will it be increased again or perhaps another drug added into the mix.
Her decision to seek a higher dose seems to have been suggested by a “pal” who is also on SSRI antidepressant medication.
“It was only when a beloved pal, and fellow citalopram taker, pointed out that she comes up to my knee, yet is on the same dose — one that probably gets absorbed merely by my left breast — that it occurred to me that a solution might be possible.”
She is by her own admission “a staunch advocate of medication” and comes from a medical family. However, as she has been on the medication for 8 years she will not have had the opportunity to find out if she is able to get off these drugs, she may be lucky but she may not and she may find herself in the same situation as the thousands of patients online desperately seeking help and support as they try to withdraw.
She quotes Professor Carmine Pariante of King’s College, London whom she interviewed last year before any of the recent publicity about the Lancet meta-analysis, the formal complaint to RCPsych about the letter in the Times newspaper, or the more recent publicity providing more details about prescribing rates.
“If prescriptions are going up, this simply means that more people are asking for help. More significant is that only a third of people suffering from depression actually seek help.”
Clearly she is unaware that research into antidepressant prescribing rates has shown that patients are being prescribed them for longer as per clinical guidelines and this also is a significant explanatory factor and the fact that many patients cannot get off the drugs is a real and pressing concern of course. Many, many patients have been consigned to a lifetime on antidepressants having been wrongly advised that they had a “chemical balance” in the brain that needed to be fixed by SSRI antidepressants. This myth is alive and well as evidenced by LBC radio’s recent programme on this subject.
She does not even question the statement that only a third of people suffering from depression actually seeks help. There are 9 million patients approximately in the UK on antidepressants. If only one third is seeking help, how can these figures be explained? In February it was stated in the Times newspaper that 2 million patients are estimated to be suffering from major depressive disorder and only one in six get the help they need which equates to around 330,000. Prof John Geddes of Oxford University said that GPs are squeamish about prescribing and patients are squeamish about taking antidepressants. I found this an incredible statement to make.
Personally, I cannot fathom then why 9 million patients are on these drugs. Does this mean that patients with mild or moderate depression flock to their GPs whilst those who are more depressed stay away. Surely not? I have repeatedly asked the psychiatrists making these statements for an explanation but I never receive a response. Surely if the public is to understand what is happening, they should not be fed this mishmash of assumptions that quite simply do not add up.
Hannah Betts cites a previous article she has written about antidepressants which provides further insight and opinions on the subject of antidepressants.
The article begins ..
“Allow me to introduce myself. I am a journalist with a fulfilling career, a happy relationship, and a large and supportive social group. I’ve also been on the antidepressant citalopram for the past seven years. I have to email my doctor to ascertain how long it has been because this situation is my old, new normal. I’m open about it, have written about it — even put a packet on my Instagram feed to counteract all those #blessings-type posts, because my happiness comes in pill form.”
Clearly if we all want a happy life we need to see our GP as soon as possible and tell him we are depressed. She certainly paints a very enticing picture and we wonder why prescribing rates are soaring with no end in sight.
Hannah Betts continues.
“I’m not alone. In June, the NHS announced that the number of prescriptions for antidepressants (ADs) is growing faster than that of any other type of medication. Last year, 64.7 million antidepressant items were prescribed in England, up 6 per cent in a year. The figures represent an all-time high — and four times as much pill popping as 20 years ago. Meanwhile, according to NHS Digital, the number of antidepressant items prescribed in London and the Thames Valley area increased by more than 18 per cent in the three years to March 2017, with some 7.8 million items prescribed in 2016/ 17.
Hysteria ensued. One paper produced the headline, ‘A dribbling, suicidal mess — until I kicked the kill pills’, to coincide with a BBC Panorama episode entitled ‘A Prescription for Murder?’ The programme asked: ‘Is it possible that a pill prescribed by your doctor can turn you into a killer?’ (Answer: probably not, given that the reaction it was describing afflicts a ‘tiny minority’, if any.)”
She clearly is unsure if antidepressants can cause violence and result in homicide. I was indeed warned of this risk some 30 years ago with respect to Prozac. She thinks hysteria ensues when patients describe serious adverse effects but it is perfectly acceptable for her to laud the praises of antidepressants and describe them as “happy pills”. Perhaps she is referring to Katinka Blackford Newman who thought she had killed her own children after being prescribed an SSRI. The dreadful ordeal this woman had to endure clearly does not warrant any sympathy from Hannah Betts. Perhaps she does not know that a specific genetic mutation can render patients unable to metabolise SSRIs properly.
There certainly was some hysteria about the Panorama programme but it mainly emanated from RCPsych in their desperation to discredit it even before the programme was aired. Otherwise it seemed a very balanced and thoughtful documentary which provided some considerable insight into the subject and resulted in very thoughtful debate in many quarters. In most mass shootings the perpetrator is killed, on this occasion it was extremely enlightening to hear Prof David Healy’s accounts of the interviews with the mass shooter. Following the programme, the RCPsych set up a Q&A session on Twitter where hundreds of questions were submitted, mainly by those of us concerned about the harmful effects of SSRIs, only a small number were answered and not in any meaningful way. I am not sure what the purpose of the session had been but assume it was designed to divert attention away from the Panorama programme and its content.
Hannah Betts continues ..
“Most people take ADs for a short time to address a specific challenge. Lucy, 43, a teacher from Blackheath, is typical. ‘I used to take fluoxetine in my late-30s, following a bereavement,’ she explains. ‘I was depressed, tearful, under a black cloud — literally shuffling. When my doctor prescribed pills, I sobbed with relief. I got severe headaches, but ploughed on, wanting, beyond anything, to feel better. It worked — like a miracle.’ Gradual withdrawal is recommended after nine months of medicated wellbeing, when side effects can include nightmares, headaches, and pins and needles. Lucy, who continued on ADs for two years, managed to avoid this.”
Whether mind altering chemicals are the best solution for grief is a debatable question. However, this lady did successfully taper off which is a blessing but so many patients are less fortunate.
“Ben is a 28-year-old medic from Kensington. ‘Smoking, drinking and my beloved hashish did a good job of masking the misery,’ he says. ‘However, I began to realise that what I felt was not entirely to do with my personality, or circumstances, but a chemical imbalance that some have and other “normal” people don’t. Eight months on sertraline, and — for the first time ever — I feel positive.’
Clearly Ben is a doctor and believes that he has a chemical imbalance in his brain that needs to be fixed. In the next part of this article, Professor Pariante confirms this imbalance was only ever a theory and a simplistic one at that. Apparently the drugs “stimulate the growth of new brain cells and regulate stress hormones” but no mention is made of the many patients made terribly sick by consuming these drugs. Professor Pariante thinks the idea of a chemical imbalance makes sense to many, but does not seem to realise that this has been hugely misleading to millions, highly damaging, was a marketing tool used by the drug companies to make billions of dollars (in which they have succeeded) and has in fact resulted in mass public deception. Even now, antidepressants are likened to insulin for diabetes – for example, by Prof Clare Gerada, in a recent Royal Society of Medicine podcast. I do not have diabetes but my understanding is that patients are tested for a deficiency of insulin rather than being given it in the hope that there might just be a deficiency in the first place. This comparison was made also on LBC radio on 21st July to explain why patients need SSRIs.
“Experts argue that the ‘chemical imbalance’ theory is simplistic. Professor Carmine Pariante of King’s College, London, tells me: ‘The action of antidepressants is more complex than that and involves stimulating the birth of new brain cells and regulating stress hormones.’ However, it’s a shorthand that makes sense to many.”
The article continues.
“Whatever their motivation, for most people who take them, ADs are a normal, quotidian thing: a practical choice with no disturbing consequences. As Professor Wendy Burn, president of the Royal College of Psychiatrists, says: ‘In mild cases, doctors tend to wait and see before prescribing: recommending talking therapies and lifestyle changes. But, yes, the pills do work… The effect can be instant, although we say two weeks to see an improvement, six weeks for full benefits.’’
Yes, it is true that many patients take them daily, often for many years or even decades having no awareness of the harm to the brain and body. They make repeated consultations with doctors for a whole myriad of symptoms which are never attributed to the drugs, they are sent for tests and investigations which never get to the root cause. They are eventually told they have medically unexplained physical symptoms and hived off to CBT so they can think differently about their unpleasant symptoms and learn to manage them. Eventually after years of trying to work out what is wrong, it finally clicks it may actually be the drugs. The process of sharing with others online will often clarify and confirm these suspicions as it is only then that patients truly find out what these drugs can do, things their doctors may well not know or will never tell them.
The article continues and we finally get to the nub of the problem, the reason why thousands and thousands of patients are congregating online whilst their doctors claim to have no idea what is wrong with them.
“Some are less convinced and have questioned whether effective non-pharmaceutical options, such as therapy, are being sidelined in favour of immediately medicating. Science writer Robert Whitaker, author of Anatomy of an Epidemic, argues that ‘antidepressants are being prescribed for general unhappiness, or for people going through some difficulty. And then, once a person starts an AD, a significant percentage continue to take the drug long-term, partly because it can be so difficult to withdraw. The rising number of people on ADs should really be conceptualised as a “drug use” problem, rather than a barometer of “unhappiness”. This is a big problem for our society. Many could be said to be addicted, and long-term risks include a significant possibility that people will become chronically depressed, a condition called “tardive dysphoria”.”
Certainly, locating the right drug can prove a disturbing process. Martha, a 32-year-old marketing manager from Clapham, is a veteran of this process. ‘As a teenager, Seroxat gave me auditory hallucinations, night sweats and made me suicidal,’ she says. ‘Coming off it was like coming off heroin. Later, I tried nearly every other AD — all gave me severe nausea, hair loss or acute anxiety — until, finally, we hit on sertraline.’
I have met many patients online, started on these drugs as teenagers, this leads to consumption of many different drugs over the years until finally patients realise they have no idea who they are as they were never able to mature properly into adults and have been medicated for a large part of their adult lives. Such patients wish to become drug free but sadly find their brains have been chemically altered and the damage may simply be too great to ever function normally. Sadly these patients will never know who they truly are. This has been my experience although I was 20 when I was first medicated and this continued for 35 years. I have lived a life with my brain altered by chemicals always believing it was my “mental health”. Of course many patients live with life-long health conditions which require medication, but when the brain is altered, the person is also altered, this is nothing like taking insulin for diabetes, there is simply no comparison.
If those of us seriously harmed by prescribed drugs of dependence are indeed “rare cases” why are we not given the best of care, we would hardly cost a great deal of money, but of course we are cast aside, unwelcome on the NHS, accused of stigmatising mental health treatments, people to be kept under the radar, to be kept silent. But not any longer. There is of course no research, no one knows how many patients are seriously harmed yet the assumption is made that we must be few in number in much the same way as other assumptions are made about SSRI antidepressants and their effectiveness.
Perhaps Hannah Betts would like to do more research and perhaps in doing so she can find out what the statistics presented by Prof Pariante really mean. Can she answer these questions?
- How is it estimated that 2 million have major depressive disorder?
- If only 1 in 3 seek help and only 1 in 6 get help, why are 9 million on the drugs?
- Why is it that huge swathes of the population seek help for mental health issues but 5 out of 6 of those with major depressive disorder do not even go to a GP?
- Why is RCPsych so keen to downplay the issues of dependence and the immense difficulties of withdrawal and resulting iatrogenic harm? After all everyone agrees that all drugs have side effects, often serious side effects.
- Why after many years of promoting the idea of a “chemical imbalance” do they not ensure this myth is completely dispelled or at least fully explained?
I am not a journalist and I do not have the privilege of interviewing leading psychiatrists.
Perhaps RCPsych could organise a TV discussion involving psychiatrists and patients .. those who benefit and those seriously harmed, this could then be widely circulated to the public and explanations given for the many conundrums around this subject.
Note – if there are mistakes in this blog, it is due to the brain damage I have sustained and serious cognitive deficits. If you value your brain, be very careful what you agree to consume. However, my brain is not so impaired that I cannot see what is happening around this subject and there are so many flaws in the arguments, it is like the sieve in my kitchen. I would dearly love some help to plug the holes.